RAJIV GANDHI UNIVERSITY OF

HEALTH SCIENCES

KARNATAKA STATE

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

MS.NILOFUR BANUS,

1st. YEAR M.Sc. NURSING

OBSTETRICS AND GYNAECOLOGICAL NURSING

2011 – 2013,

REV NOORUNNISSA COLLEGE OF NURSING,

KARNATAKA

1 / NAME OF THE CANDIDATE AND ADDRESS / MS.NILOFUR BANUS
1st YEAR M.Sc. NURSING STUDENT,
REV.NOORUNNISSA COLLEGE OF NURSING,
AI-HAJMA NOORUNNISSA ROAD,
ANDRESONPET, KG. F-563113
2 / NAME OF THE INSTITUTION / REV.NOORUNNISSA COLLEGE OF NURSING,
AI-HAJMA NOORUNNISSA ROAD,
ANDRESONPET, KG. F-563113
3 / COURSE OF STUDY AND SUBJECT / MASTER OF SCIENCE IN NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
4 / DATE OF ADMISSION TO THE COURSE /
26/06/2011
5 / TITLE OF THE TOPIC / “EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME (STP) ON KNOWLEDGE REGARDING PREVENTION AND MANAGEMENT OF LOW BIRTH WEIGHT BABIES AMONG STAFF NURSES”.
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURE TEACHING PROGRAMME (STP) ON KNOWLEDGE REGARDING PREVENTION AND MANAGEMENT OF LOW BIRTH WEIGHT BABIES AMONG STAFF NURSES IN SELECTED HOSPITALS AT KGF.”

6. BRIEF RESUME OF THE INTENDED WORK

6.1 Introduction

“There is no indicator in human biology, which tells us so much about the past
Events and the future trajectory of life, as the weight of infant at birth.”
– V. Ramalingaswami

Birth weight is the first weight of a live or still born baby which should preferably be taken within the first hour of life. Low birth weight (LBW) is a term used to describe babies who are born weighing less than 2500 grams (5pounds, 80 ounces) in contrast, the average new born weighs about 7 pounds.1 Babies with a birth weight of less than 1500 gram (up to and including 1499 gram) are considering as very low birth weight (VLBW) babies and babies with a birth weight of less than 1000 gram considering as extremely low birth weight (ELBW) babies.

Low birth weight babies are broadly of two clinical types. First are those born before 37 weeks (pre term) because birth weight is a function of gestation, a preterm baby is expected to have less in weight. Secondary category of LBW infants includes those babies who have intrauterine growth retardation (IGUR). These babies are under nourished (or small) for a given gestation (dates). They are, therefore called small for gestational age (SGA) or small for dates (SFD) babies.3Over 80 percent of all neonatal mortality in both the developed and developing countries occur among the LBW babies. 1

In India alone 6 to 8 million low birth weight infants are born annually. High incidence of LBW babies in our country is accounted for by a higher number of babies with intra uterine growth retardation. (small for dates) rather than the pre term babies.2 The main problems of low birth weight babies are birth asphyxia hypothermia feeding difficulties, infections, hypobilirubinemia, apnenic spells, respiratory distress, hypoglycemia, and meconium aspiration syndrome etc.3 Any baby born prematurely is more likely to be very small. However there are other factors that can also contribute to the risk of very low birth weight. These includes:-

·  Race – African- American babies are two times more likely to have low birth weight than Caucasian babies.

·  Age – Teen mothers (especially those younger than 15 years old) have a much higher risk of having a baby with low birth weight.

·  Multiple birth - Multiple birth babies are increased risk of low birth weight because they often are premature. Over half of twins and other multiples have low birth weight.

·  Mother’s health- babies of mothers who are exposed to illicit drugs, alcohol, and cigarette are more likely to have low birth weight. Mothers of lower socioeconomic status are also more likely to have poorer pregnancy nutrition, inadequate pre natal care and pregnancy complications all factors that can contribute to low birth weight.1

The management of low birth weight babied often include care in the NICU, exclusive breast feeding, temperature control, kangaroo care, special feedings (nutrition and fluids) – sometimes with a tube into the stomach if baby cannot suck, infection control, home care and some other treatments for complications.1 Home care to LBW infant is provided best by the mother. Prevention of pre term birth is one of the best ways to prevent babies born with low birth weight. Prenatal care is a key factor in preventing pre term births and low birth weight babies. At prenatal visits, the health of both mother and fetus can be checked because maternal nutrition and weight gain are linked with fetal weight gain and birth weight. Eating a healthy diet and gaining the proper amount of weight in pregnancy are essential. Mother should also avoid alcohol, cigarettes and illicit drugs, which can contribute to poor fetal growth, among other complications.1

Incidence of low birth weight in our country is very high. High risk mother should be identified early during the course of pregnancy and referred for confinement to an appropriate health care facility. Nurse has to offer support and comfort to mother and reassure her of her capabilities. The management of LBW babies includes hospital management and home management which are care at birth, thermal protection, fluid and feeds, kangaroo mother care, infection control and appropriate management of specific complications.

6.2 Need for the Study

“A baby is an inestimable blessing and bother”

Mark Twain

Low birth weight is one of the most serious challenges in maternal and child health in both developed and developing countries. The lower birth weight; the lower is the survival chance. Main attention has been given in recent years to ways and means of preventing LBW through good prenatal care and intervention programs, rather than treatment of LBW babies born later.4 WHO estimates that globally about 25 million low birth weight babies are born at each year, consisting 17 percent of all live births, nearly 95 percent of them in developing countries. In India, it is about 26 to 30 % of all live births, in which more than half of them are born at term .Govt. of India wished to control this problem and decrease the incidence to 10 % by the year 2000.but not achieved till now.5

The Hindu news paper reported that the current neonatal mortality rate (NMR) of 44 deaths per 1000 live births accounted for nearly two thirds of the global infant mortality and half of the global child mortality. The study also pointed out that undivided states of Uttar Pradesh, Madhya Pradesh, and Bihar together accounted for over 50% of the number of neonatal deaths in India in the year 2000.The study has revealed that almost eight million low birth weight infants were born in India every year. It is also said that 75% of neonatal deaths occurred in infants with low birth weight.6

In Karnataka, the RCH survey data on birth weight observed that about 20% of the infants were below 2,500 grams; in many districts more than one – fifth of the infants were reportedly under weight. The lowest proportion of under weight babies was in Bangalore Urban (9%) and the highest in Dharwad district (39%).In Hassan district, reports pointed out about 786 cases of LBW and associated problems in 2008. More than half of the districts had more than 20 percent under weight babies.7

In India a study shows 39.1% prevalence of low birth weight babies in an urban resettlement area of Delhi. Occurrence of LBW was related to age, parity, weight and height of the mother. Thus prevalence of LBW remains high in the urban under privileged of Delhi.8

A study was conducted in Udupi thaluk, Karnataka, with aim to identify the socio demographic, maternal and obstetric determinants of low birth weight; the result shows that primes, elderly mothers and mothers who had not received good quality antenatal care were found to be more at risk of having low birth weight babies.16

In university of Winconsin conducted a continuing education program for hospital and public health nurses to guide families of very low birth weight infants in care giving. Nurses have a critical role in family development of competencies for giving care to very low birth weight infants.9

The nurses have great role in reducing neonatal morbidity and mortality through the care of low birth weight baby because in the initial days they are the prime care givers to the newborn baby. . So nurses should have a proper knowledge about the care. Based on the experiences of the researcher realized the increased incidence of LBW and its effects in life and deficiency of knowledge among staff nurses. Thus the investigator has decided to design study on self instructional module regarding prevention and management of low birth weight babies.

6.3 Statement of the Problem

“A study to assess the effectiveness of structured teaching programme on knowledge regarding prevention and management of low birth weight babies among staff nurses in selected hospitals at KGF, Karnataka”.

6.4 Objectives of the Study

·  To assess the knowledge of staff nurses regarding prevention and management of low birth weight babies through pre-test.

·  To assess the knowledge of staff nurse regarding prevention and management low birth weight babies after the structured teaching programme through post-test.

·  To compare pre- test and post- test knowledge of staff nurses regarding prevention and management of low birth weight babies.

·  To associate knowledge of staff nurses regarding prevention and management of low birth weight babies with selected socio demographic variables.

6.5 Hypotheses

H1: There will be significant differences between the pre-test and post-test level of knowledge among staff nurses regarding prevention and management of low birth weight babies.

H2: There will be significant association between post-test knowledge scores of staff nurses with selected socio demographic variables.

6.6 Assumptions

·  Staff nurses have some knowledge regarding prevention and management of low birth weight babies.

·  This study will improve the knowledge of staff nurses about the prevention and management of low birth weight babies.

·  Staff nurses are interested to learn about prevention and management of low birth weight newborns

6.7 Operational Definition

·  Assess:-It refers to statistical measurement of knowledge of staff nurses regarding prevention and management of low birth weight babies.

·  Effectiveness:-It refers to a process which produces an intended result on knowledge among staff nurses regarding prevention and management of low birth weight babies.

·  Structured teaching programme:-It is a systematically prepared teaching programme to educate the staff nurses about the management and care of low birth weight babies.

·  Knowledge:-It refers to the relevant information regarding prevention and management of low birth weight babies.

·  Prevention:-It refers to the action which halts the occurrence of low birth weight in newborn.

·  Management:-It refers to measures which can treat or increase the weight of low birth weight babies and it includes both hospital and home management.

·  Low birth weight babies:-It refers to the newborn those who weigh less than 2.5 kg at birth regardless of gestational age.

·  Staff nurses:-It refers to the professional registered nurses those who are working in selected hospitals at KGF.

6.8 Criteria for Sample Selection

Inclusion criteria

·  Staff nurses those who are working in the women and children hospital.

·  Staff nurses who are willing to participate in the study.

Exclusion criteria

·  Staff nurses those who are not available during data collection.

·  Staff nurses who are not willing to participate in this study.

·  Staff nurses who have undergone special training in management of low birth weight baby.

6.9 Delimitations

·  This study is limited to staff nurses working in selected hospitals at KGF.

·  Sample is limited to 60 staff nurses.

·  This study is limited to 4 to 6 weeks.

6.10 Significance of the Study

This study will promote the knowledge of staff nurses regarding the prevention and management of low birth weight babies.

6.11 Conceptual Framework

The conceptual frame work of this study is based on Ludwig Von Bertalanffy‘s general system theory

6.12 Review of Literature

Review of literature is a key step in research process. It provides valuable help in the development of knowledge of research projects. It also supports and explains why the proposed topics taken for research and avoid unnecessary duplication explore the feasibility and illuminate way to new research.20

A study was conducted at Delhi, India with an aim to evaluate the prevalence and determinants of LBW in an urban resettlement area. A baseline survey was done to enroll all pregnant women in the area. These women were followed up every month till outcome. The prevalence of LBW was 39.1% .Occurrence of LBW was related to age, parity, weight and height of the mother. In multiple logistic regression analysis, mother’s weight and parity alone emerged as significant variables. Thus; prevalence of LBW remains high in the urban under privileged of Delhi.8

A study to evaluate the effectiveness of planned teaching regarding assessment of LBW infants in terms of knowledge and skills of nursing personnel working in neonatal care unit in a selected hospital of Delhi. The study results showed that the mean post-test knowledge score (44.47) and skill score were significantly higher than the mean pre-test knowledge scores and skill scores (17.91) (p<0.01). There was a significant positive coefficient of correlation (0.41) between post-test knowledge score and skill score (p<0.05). Thus the PTP was effective in enhancing knowledge as well as skill of nursing personnel regarding assessment of LBW infants10

A cohort study was conducted at Nagpur with an objective to determine the prevalence of low birth weight and its association with maternal factors. The result revealed that low birth weight prevalence was 30.3%.On multivariate analyses the maternal factors significantly associated with LBW were anemia (OR-4.81), low socioeconomic status (OR-3.96), short birth interval (OR-3.84), tobacco exposure (OR-3.14), height (OR-2.78), maternal age (OR-2.68), body mass index (OR-2.02) and primiparity. They concluded that anemia, low socio economic status, short stature, short birth interval, tobacco exposure, low maternal age, low body mass index and primiparity are significantly risk factors for low birth weight.11